Immunisations

Renal Transplantation Protocol: Immunisations

A. Killed Vaccines Pre-Transplant Post-Transplant
Tetanus / diphtheria / inactive polio1 Yes
Hepatitis B Yes Yes
Influenza Yes Yes
Typhoid (inactive polysaccharide vaccine) Yes Yes
Pneumococcal / Meningococcal / Hib Yes
Combined Hepatitis A / B (TWINRIX) Yes Yes

B. Live Vaccines Pre-Transplant Post-Transplant
MMR2 Yes Contraindicated
Varicella Yes Not recommended
BCG Yes Contraindicated
Yellow Fever Vaccine Yes Contraindicated

Notes:

  • There is no risk of infection from vaccines and susceptible contacts.
  • Measles – patients who are immunosuppressed and come into contact with measles should receive HNIG (human normal immunoglobulin) as soon as possible, but within 6 days.
  • Chickenpox – Varicella zoster immunoglobulin (VZIG) is indicated in patients who have had significant exposure to chickenpox or shingles and who have no antibodies to VZ.  VZIG should be given within 7 days of contact.
  • Yellow Fever – patients post-transplant intending to travel to countries where a Yellow Fever vaccination certificate is mandatory should obtain a letter of exemption from a medical practitioner.  (Yellow Fever occurs in tropical Africa and in South America – see WHO website for details.)

Malaria Prophylaxis – up-to-date information on Malaria prophylaxis for a given destination is available from pharmacy.  The following table gives an indication of interactions:

Tacrolimus Ciclosporin
Choloroquine tacrolimus (CP450 3A4) CyA (CP450 3A4)
Proguanil No interactions likely No interaction
likely
Mefloquine tacrolimus (displacement from plasma
protein)
No interaction
likely
Doxycycline tacrolimus (CP450 3A4) CyA (CP450 3A4)